Approach to the care of long-term testicular cancer survivors
- Clair J Beard, MD
Clair J Beard, MD
- Associate Professor of Radiation Oncology
- Harvard Medical School
- David J Vaughn, MD
David J Vaughn, MD
- Professor of Medicine
- Abramson Cancer Center of the University of Pennsylvania
- Section Editors
- Larissa Nekhlyudov, MD, MPH
Larissa Nekhlyudov, MD, MPH
- Section Editor — Cancer Survivorship
- Director of Cancer Research
- Department of Population Medicine
- Associate Professor
- Harvard Medical School
- Patricia A Ganz, MD
Patricia A Ganz, MD
- Section Editor — Cancer Survivorship
- UCLA Schools of Medicine and Public Health
- Jonsson Comprehensive Cancer Center
Testicular cancer is the most curable solid tumor and the most common malignancy in men between the ages of 18 and 35. The overall survival rate after diagnosis and treatment of testicular cancer exceeds 96 percent at 10 years. Following treatment for testicular cancer, oncologic follow-up is guided in part by the probability of relapse over time. Although most relapses occur within the first five years, late recurrences can occur.
During the period of oncologic follow-up, after active therapy or any time thereafter, patients with a history of testicular cancer may develop symptoms that affect quality of life or have abnormal findings on clinical examination . Both primary care clinicians and oncologists may be challenged with questions related to whether or not these symptoms or findings are due to prior treatment.
Because of the young age at which men with testicular cancer are diagnosed and success in treatment of testicular cancer, issues of cancer survivorship evolve as men mature. This topic will cover late treatment-related complications in testicular cancer survivors. The discussion is intended for the management of patients who have completed the active phase of cancer therapy and have transitioned to receiving almost all of their care from their primary care clinician. Acute treatment-related toxicity and posttreatment follow-up of men treated for testicular cancer are discussed in more detail separately. (See "Treatment-related toxicity in men with testicular germ cell tumors" and "Posttreatment follow-up for men with testicular germ cell tumors".)
A general overview of cancer survivorship is discussed separately. (See "Overview of cancer survivorship care for primary care and oncology providers".)
OVERVIEW OF TREATMENT FOR TESTICULAR CANCER
Testicular cancer affects fewer than 9000 men in the United States each year and usually presents as a nodule or painless swelling of one testicle, which may be noted incidentally by the patient or by his sexual partner [2,3]. The vast majority of testicular cancers are germ cell tumors, which are classified as either seminomas or non-seminomatous germ cell tumors (NSGCTs). Approximately 90 percent are detected with low-stage disease (stage I to IIB) (table 1), and most (60 to 80 percent) will have clinical stage I disease .
- Gilligan T. Quality of life among testis cancer survivors. Urol Oncol 2015; 33:413.
- Motzer RJ, Agarwal N, Beard C, et al. Testicular cancer. J Natl Compr Canc Netw 2012; 10:502.
- Bosl GJ, Motzer RJ. Testicular germ-cell cancer. N Engl J Med 1997; 337:242.
- Richie JP, Sheinfeld J. Introduction: International consultation on urologic diseases: testicular cancer: Societe Internationale d'Urologie/International Consultation on Urologic Diseases Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009. Urology 2011; 78:S425.
- Girasole CR, Cookson MS, Smith JA Jr, et al. Sperm banking: use and outcomes in patients treated for testicular cancer. BJU Int 2007; 99:33.
- Woodruff TK. The Oncofertility Consortium--addressing fertility in young people with cancer. Nat Rev Clin Oncol 2010; 7:466.
- Jacobs LA, Vaughn DJ. Hypogonadism and infertility in testicular cancer survivors. J Natl Compr Canc Netw 2012; 10:558.
- Bayens YC, Helle PA, Van Putten WL, Mali SP. Orchidectomy followed by radiotherapy in 176 stage I and II testicular seminoma patients: benefits of a 10-year follow-up study. Radiother Oncol 1992; 25:97.
- Ellerbroek NA, Tran LM, Selch MT, et al. Testicular seminoma. A study of 103 cases treated at UCLA. Am J Clin Oncol 1988; 11:93.
- Daugaard, G, Roerth, M. Observation and expectant management for low-stage seminoma and nonseminoma. In: Comprehensive Textbook of Genitourinary Oncology, 2nd, Vogelzang, NJ, Scardino, PT, Shipley, WU, Coffey, DS (Eds), Lippincott, Williams and Wilkins, Philadelphia 2000. p.976.
- Oldenburg J, Alfsen GC, Waehre H, Fosså SD. Late recurrences of germ cell malignancies: a population-based experience over three decades. Br J Cancer 2006; 94:820.
- Geldart TR, Gale J, McKendrick J, et al. Late relapse of metastatic testicular nonseminomatous germ cell cancer: surgery is needed for cure. BJU Int 2006; 98:353.
- Wethal T, Kjekshus J, Røislien J, et al. Treatment-related differences in cardiovascular risk factors in long-term survivors of testicular cancer. J Cancer Surviv 2007; 1:8.
- Feldman DR, Schaffer WL, Steingart RM. Late cardiovascular toxicity following chemotherapy for germ cell tumors. J Natl Compr Canc Netw 2012; 10:537.
- Abouassaly R, Fossa SD, Giwercman A, et al. Sequelae of treatment in long-term survivors of testis cancer. Eur Urol 2011; 60:516.
- van den Belt-Dusebout AW, Nuver J, de Wit R, et al. Long-term risk of cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol 2006; 24:467.
- Huddart RA, Norman A, Moynihan C, et al. Fertility, gonadal and sexual function in survivors of testicular cancer. Br J Cancer 2005; 93:200.
- Brydøy M, Oldenburg J, Klepp O, et al. Observational study of prevalence of long-term Raynaud-like phenomena and neurological side effects in testicular cancer survivors. J Natl Cancer Inst 2009; 101:1682.
- Fung C, Fossa SD, Milano MT, et al. Cardiovascular Disease Mortality After Chemotherapy or Surgery for Testicular Nonseminoma: A Population-Based Study. J Clin Oncol 2015; 33:3105.
- Willemse PM, Burggraaf J, Hamdy NA, et al. Prevalence of the metabolic syndrome and cardiovascular disease risk in chemotherapy-treated testicular germ cell tumour survivors. Br J Cancer 2013; 109:60.
- Hamilton CR, Horwich A, Bliss JM, Peckham MJ. Gastrointestinal morbidity of adjuvant radiotherapy in stage I malignant teratoma of the testis. Radiother Oncol 1987; 10:85.
- Stensvold E, Aass N, Gladhaug I, et al. Erroneous diagnosis of pancreatic cancer after radiotherapy of testicular cancer. Eur J Surg Oncol 2004; 30:352.
- Sleijfer S. Bleomycin-induced pneumonitis. Chest 2001; 120:617.
- Dearnaley DP, Horwich A, A'Hern R, et al. Combination chemotherapy with bleomycin, etoposide and cisplatin (BEP) for metastatic testicular teratoma: long-term follow-up. Eur J Cancer 1991; 27:684.
- O'Sullivan JM, Huddart RA, Norman AR, et al. Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours. Ann Oncol 2003; 14:91.
- Huddart RA, Birtle AJ. Recent advances in the treatment of testicular cancer. Expert Rev Anticancer Ther 2005; 5:123.
- Nord C, Bjøro T, Ellingsen D, et al. Gonadal hormones in long-term survivors 10 years after treatment for unilateral testicular cancer. Eur Urol 2003; 44:322.
- Oldenburg J. Hypogonadism and fertility issues following primary treatment for testicular cancer. Urol Oncol 2015; 33:407.
- Brydøy M, Fosså SD, Klepp O, et al. Paternity following treatment for testicular cancer. J Natl Cancer Inst 2005; 97:1580.
- Ondrusova M, Ondrus D, Dusek L, Spanikova B. Damage of hormonal function and bone metabolism in long-term survivors of testicular cancer. Neoplasma 2009; 56:473.
- Dahl AA, Bremnes R, Dahl O, et al. Is the sexual function compromised in long-term testicular cancer survivors? Eur Urol 2007; 52:1438.
- Fosså SD, Aass N, Winderen M, et al. Long-term renal function after treatment for malignant germ-cell tumours. Ann Oncol 2002; 13:222.
- Sprauten M, Darrah TH, Peterson DR, et al. Impact of long-term serum platinum concentrations on neuro- and ototoxicity in Cisplatin-treated survivors of testicular cancer. J Clin Oncol 2012; 30:300.
- Travis LB, Beard C, Allan JM, et al. Testicular cancer survivorship: research strategies and recommendations. J Natl Cancer Inst 2010; 102:1114.
- Niitsu Y, Takahashi Y, Ban N, et al. A proof of glutathione S-transferase-pi-related multidrug resistance by transfer of antisense gene to cancer cells and sense gene to bone marrow stem cell. Chem Biol Interact 1998; 111-112:325.
- Peklak-Scott C, Smitherman PK, Townsend AJ, Morrow CS. Role of glutathione S-transferase P1-1 in the cellular detoxification of cisplatin. Mol Cancer Ther 2008; 7:3247.
- Gikas PD, Hanna SA, Aston W, et al. Post-radiation sciatic neuropathy: a case report and review of the literature. World J Surg Oncol 2008; 6:130.
- Bauer CA, Brozoski TJ. Cochlear structure and function after round window application of ototoxins. Hear Res 2005; 201:121.
- Stava C, Beck M, Schultz PN, Vassilopoulou-Sellin R. Hearing loss among cancer survivors. Oncol Rep 2005; 13:1193.
- Frisina RD, Wheeler HE, Fossa SD, et al. Comprehensive Audiometric Analysis of Hearing Impairment and Tinnitus After Cisplatin-Based Chemotherapy in Survivors of Adult-Onset Cancer. J Clin Oncol 2016; 34:2712.
- Shim K, MacKenzie MJ, Winquist E. Chemotherapy-associated osteonecrosis in cancer patients with solid tumours: a systematic review. Drug Saf 2008; 31:359.
- Cook AM, Dzik-Jurasz AS, Padhani AR, et al. The prevalence of avascular necrosis in patients treated with chemotherapy for testicular tumours. Br J Cancer 2001; 85:1624.
- Winquist EW, Bauman GS, Balogh J. Nontraumatic osteonecrosis after chemotherapy for testicular cancer: a systematic review. Am J Clin Oncol 2001; 24:603.
- Fung C, Fossa SD, Beard CJ, Travis LB. Second malignant neoplasms in testicular cancer survivors. J Natl Compr Canc Netw 2012; 10:545.
- Richiardi L, Scélo G, Boffetta P, et al. Second malignancies among survivors of germ-cell testicular cancer: a pooled analysis between 13 cancer registries. Int J Cancer 2007; 120:623.
- Travis LB, Fosså SD, Schonfeld SJ, et al. Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst 2005; 97:1354.
- Wanderås EH, Fosså SD, Tretli S. Risk of subsequent non-germ cell cancer after treatment of germ cell cancer in 2006 Norwegian male patients. Eur J Cancer 1997; 33:253.
- van den Belt-Dusebout AW, de Wit R, Gietema JA, et al. Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol 2007; 25:4370.
- Fung C, Fossa SD, Milano MT, et al. Solid tumors after chemotherapy or surgery for testicular nonseminoma: a population-based study. J Clin Oncol 2013; 31:3807.
- Raghavan D, Zalcberg JR, Grygiel JJ, et al. Multiple atypical nevi: a cutaneous marker of germ cell tumors. J Clin Oncol 1994; 12:2284.
- Travis LB, Andersson M, Gospodarowicz M, et al. Treatment-associated leukemia following testicular cancer. J Natl Cancer Inst 2000; 92:1165.
- Fosså SD, Chen J, Schonfeld SJ, et al. Risk of contralateral testicular cancer: a population-based study of 29,515 U.S. men. J Natl Cancer Inst 2005; 97:1056.
- Andreassen KE, Grotmol T, Cvancarova MS, et al. Risk of metachronous contralateral testicular germ cell tumors: a population-based study of 7,102 Norwegian patients (1953-2007). Int J Cancer 2011; 129:2867.
- Mock V, Atkinson A, Barsevick A, et al. NCCN Practice Guidelines for Cancer-Related Fatigue. Oncology (Williston Park) 2000; 14:151.
- Orre IJ, Fosså SD, Murison R, et al. Chronic cancer-related fatigue in long-term survivors of testicular cancer. J Psychosom Res 2008; 64:363.
- Thorsen L, Nystad W, Stigum H, et al. The association between self-reported physical activity and prevalence of depression and anxiety disorder in long-term survivors of testicular cancer and men in a general population sample. Support Care Cancer 2005; 13:637.
- Dahl AA, Haaland CF, Mykletun A, et al. Study of anxiety disorder and depression in long-term survivors of testicular cancer. J Clin Oncol 2005; 23:2389.
- Beard CJ, Travis LB, Chen MH, et al. Outcomes in stage I testicular seminoma: a population-based study of 9193 patients. Cancer 2013; 119:2771.
- Lauritsen J, Kier MG, Mortensen MS, et al. Germ Cell Cancer and Multiple Relapses: Toxicity and Survival. J Clin Oncol 2015; 33:3116.
- Buchler T, Kubankova P, Boublikova L, et al. Detection of second malignancies during long-term follow-up of testicular cancer survivors. Cancer 2011; 117:4212.
- Vaughn DJ, Gignac GA, Meadows AT. Long-term medical care of testicular cancer survivors. Ann Intern Med 2002; 136:463.
- Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 2012; 62:243.
- OVERVIEW OF TREATMENT FOR TESTICULAR CANCER
- Primary surgery
- Fertility preservation
- Primary treatment
- Resection of residual disease following chemotherapy
- FOLLOW-UP POSTTREATMENT
- ORGAN-SPECIFIC EFFECTS OF TREATMENT
- Cardiovascular disease
- - Metabolic syndrome
- Gastrointestinal disorders
- Pulmonary toxicity
- - Bleomycin-induced lung injury
- - Infertility
- - Sexual dysfunction
- Renal impairment
- Peripheral neuropathy
- Non-traumatic osteonecrosis
- SECONDARY MALIGNANCIES
- Solid tumors
- Skin cancers
- Hematologic malignancies
- Contralateral testicular cancer
- CHRONIC FATIGUE
- PSYCHOLOGIC DISTRESS
- SURVIVORS AFTER SALVAGE THERAPY
- FOLLOW-UP FOR LONG-TERM SURVIVORS OF TESTICULAR CANCER
- SUMMARY AND RECOMMENDATIONS